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Background: Taller diabetic patients are at higher risk of peripheral sensory loss than shorter diabetic patients and thus may be at increased risk of lower-extremity ulcers and amputation. In a large telephone survey, the prevalence of lower-extremity amputation among patients with diabetes mellitus was determined and the association between height and lower-extremity amputation evaluated.
Methods: Of 256 036 patients identified from hospital and clinic databases who had a diagnosis of diabetes and were seen at those institutions between 1995 and 1998, 128 572 were randomly selected to be interviewed by telephone between 1995 and 2002. Of the 93 484 patients who agreed to be interviewed, 386 were excluded (age < 18 years); this left 93 116 diabetec patients (42 970 men and 50 146 women) for inclusion in the study.
Results: Of the 93 116 patients interviewed, 3259 (3.5%) had type 1 diabetes. Lower-extremity amputation was performed in 1.7% and 0.8% of the patients with type 1 and type 2 diabetes, respectively. The prevalence of amputation did not differ significantly between men and women with type 1 diabetes but was significantly higher among men than among women with type 2 diabetes (0.9% v. 0.7%). Height (every 10-cm increment) was significantly associated with lower-extremity amputation (adjusted odds ratio [OR] 1.16, 95% confidence interval [CI] 1.03–1.32). In a subgroup of 9295 patients for whom data on fasting plasma glucose levels and dyslipidemia were available, and after additional adjustment for these 2 variables, body height remained an independent predictor of lower-extremity amputation (adjusted OR for every 10 cm of height 1.79, 95% CI 1.14–2.82).
Interpretation: Height is an independent predictor of lower-extremity amputation among patients with type 1 and type 2 diabetes mellitus
Peripheral Insensate Neuropathy--A Tall Problem for US Adults?
Cheng YJ, Gregg EW, Kahn HS, Williams DE, De Rekeneire N, Venkat Narayan KM. Am J Epidemiol. 2006 Aug 11
The relation between height and lower extremity peripheral insensate neuropathy among persons with and without diabetes was examined by use of the 1999-2002 US National Health and Nutrition Examination Survey with 5,229 subjects aged 40 or more years. A monofilament was used to determine whether any of three areas on each foot were insensate. Peripheral insensate neuropathy was defined as the presence of one or more insensate areas. Its prevalence was nearly twice as high among persons with diabetes (21.2%) as among those without diabetes (11.5%; p < 0.001). Men (16.2%) had 1.7 times the prevalence of peripheral insensate neuropathy as did women (9.4%), but the difference was not significant after adjustment for height. Greater height was associated with increased peripheral insensate neuropathy prevalence among persons with and without diabetes (p < 0.001). This association was characterized by a sharp increase in prevalence among persons who were taller than 175.5 cm. Peripheral insensate neuropathy risk was significantly higher among those taller than 175.5 cm (adjusted odds ratio = 2.3, 95% confidence interval: 1.5, 3.5). The authors conclude that body height is an important correlate of peripheral insensate neuropathy. This association largely accounts for the difference in peripheral insensate neuropathy prevalence between men and women. Height may help health-care providers to identify persons at high risk of peripheral insensate neuropathy.